How do dialysis patients exercise scientifically? You must know these misunderstandings

In the public's perception, dialysis patients are often regarded as a group of people who are weak and need to stay in bed. However, scientific research and clinical practice have shown that proper exercise has many benefits for dialysis patients, improving physical function and quality of life. However, there are many misunderstandings that need to be clarified to help patients embark on the path of scientific exercise.

Myth 1: Dialysis patients can only stay in bed, and exercise is a "forbidden zone"

For a long time, the idea that "dialysis patients should stay in bed and recuperate" has been deeply rooted. Many patients and their families believe that poor kidney function, reliance on dialysis to maintain life, and extremely fragile bodies will be overwhelmed and aggravate their conditions with the slightest movement. In fact, moderate exercise is a "good medicine" for dialysis patients.

Correct answer: Although dialysis treatment replaces part of the kidney's excretion function, long-term bed rest and lack of exercise can cause muscle atrophy and weakness, slow body metabolism, and decreased cardiopulmonary function. It is also easy to cause complications such as deep vein thrombosis and joint stiffness. A clinical case shows that a 45-year-old dialysis patient, initially worried about the risks of exercise, stayed in bed for more than 3 months. As a result, his muscle mass decreased sharply, and he even had difficulty standing up, and his daily activities were severely restricted. Later, under the guidance of medical staff, he gradually started exercising, his muscle strength gradually recovered, and his mental state and ability to take care of himself were greatly improved.

The International Society of Nephrology issued a guideline stating that regular exercise can enhance muscle strength, improve cardiovascular function, and enhance psychological state for dialysis patients, provided that their physical condition allows. Of course, exercise should be combined with one's own condition and fully communicated with medical staff for planning, and should not be done blindly or radically.

Myth 2: Choose sports at random without considering your physical characteristics

Dialysis patients have special physical conditions, with abnormal kidney function and unstable internal environment, so not all sports are suitable for them. Sports such as marathons and high-intensity strength training, which require high physical fitness, metabolism, and cardiopulmonary function, can easily cause fatigue, dehydration, and electrolyte disorders, increasing the burden on the kidneys and heart.

Correct answer: Walking is the most suitable sport. It is low-intensity and easy to carry out. It can be carried out in flat areas such as residential areas and parks. Each time, it takes 20 to 30 minutes. The pace and distance can be adjusted according to one's tolerance. It helps to promote blood circulation and strengthen leg muscles. Tai Chi is also popular among dialysis patients. The movements are slow and the breathing is coordinated. Each move is a transition between movement and stillness. It regulates the rhythm of the body and mind and enhances the body's flexibility and balance. It can be practiced 3 to 4 times a week for about 30 minutes each time.

For young patients with better physical fitness and stable conditions, cycling is a good choice. Choose a flat route with less traffic and ride at a moderate speed. It can not only exercise the heart and lungs, but also enjoy the scenery and cheer up. However, you must pay attention to sun protection and hydration. The cycling time should be controlled within 1 hour to avoid excessive fatigue and dehydration.

Ba Duan Jin is also suitable for dialysis patients. Its movements are simple and elegant, combining both hardness and softness. Through stretching, twisting, flexion and extension, it can effectively dredge the meridians and harmonize Qi and blood. It does not take long to practice the whole set of exercises each time, but it can exercise the whole body. Persistent practice is effective in improving physical condition.

Myth 3: Exercise at any time without paying attention to timing

It is very important to arrange exercise time for dialysis patients, and they should not exercise whenever they want. In the short period before and after dialysis treatment, the body is in a special state, and exercise at this time can easily cause discomfort. Before dialysis, toxins and excess water accumulate in the body, and electrolytes are unbalanced. Exercise may aggravate the imbalance and cause symptoms such as dizziness and palpitations. After dialysis, the body has just undergone extracorporeal circulation and blood composition adjustment, and is relatively weak. Immediate exercise is not conducive to recovery and may even cause low blood pressure and muscle cramps.

Correct answer: The ideal time to exercise is during the days between dialysis treatments, when the body is in a relatively stable state. For example, patients who undergo dialysis on Mondays, Wednesdays, and Fridays can schedule exercise on Tuesdays and Thursdays, with each exercise session 1-2 hours after a meal to avoid gastrointestinal discomfort caused by exercise immediately after a meal, and to prevent hypoglycemia caused by exercise on an empty stomach. Also, it is not advisable to exercise too early in the morning or too late at night, so as to avoid poor temperature and light that may affect safety and exercise results.

In addition, the time of exercise should be adjusted flexibly when the seasons change and the weather changes. In the hot summer, it is better to avoid the period when the sun is shining brightly and choose the cool time in the early morning or evening. In the cold winter, it is more appropriate to exercise in the afternoon when the temperature is slightly higher to reduce the stimulation and adverse effects of the cold on the body.

Misconception 4: Not paying attention to the intensity of exercise, "overdoing it" or "doing it perfunctorily"

Controlling the intensity of exercise is a key step in scientific exercise for dialysis patients. If the intensity is too high, the body will not be able to cope with it, resulting in breathing difficulties, chest pain, extreme fatigue, etc., which will harm health; if the intensity is too low, it will be difficult to reap the benefits of exercise.

Correct answer: There are skills to judge the intensity of exercise. The "Perceived Fatigue Grading Scale" is practical. If you feel a little tired during exercise but can still talk to others normally, it is an appropriate intensity; if you are out of breath and have difficulty speaking, the intensity is excessive. You can also refer to the heart rate index. The maximum heart rate is (220 - age) × (50% - 70%), which is safer. For example, for a 50-year-old patient, it is appropriate to maintain a heart rate of 85 - 119 beats/minute during exercise. Start with low intensity for the first exercise, and then adjust carefully as your physical fitness improves and your body adapts, step by step.

It is worth noting that the intensity of exercise should also be measured in combination with one's underlying disease conditions. If you have cardiovascular disease, the intensity should be moderately reduced. If you experience palpitations, chest tightness, or other discomfort during exercise, you must stop immediately and seek medical attention and adjust your exercise plan in a timely manner.

Misconception 5: Ignoring preparation and protection before and after exercise, laying hidden dangers

Preparation and protection for dialysis patients before and after exercise are like "safety locks" and are indispensable. Before exercise, warm-up must be done properly, such as moving wrists and ankles, lunging and leg stretching, high leg raises, and other simple movements, which can be done for 5-10 minutes to wake up muscles, warm up joints, increase heart rate, and reduce the risk of sports injuries.

Correct answer: Sports equipment should be suitable. Choose comfortable sports shoes that provide arch support, are non-slip and wear-resistant, and prevent falls and sprains; wear loose and breathable clothes to help dissipate heat and sweat. After exercise, stretching and relaxation are essential. Static stretching of muscle groups, each movement for 15-30 seconds, helps eliminate muscle fatigue, relieve soreness, reduce muscle tension and stiffness after exercise, and promote the body to return to a stable state.

During exercise, carry a water bottle with you to replenish water in time to prevent dehydration; if you are outdoors, prepare a sun hat and sunscreen to avoid sunburn. At the same time, you can wear an emergency contact card with key information such as medical condition, common medications, and family contact information to prevent sudden accidents and get help in time.

Misunderstanding 6: Lack of long-term persistence and effect evaluation, giving up halfway

Some dialysis patients start their exercise program with great enthusiasm, but after a few weeks, they see no obvious results or give up halfway due to laziness. This is a pity. Scientific exercise is a gradual and continuous accumulation process for dialysis patients, and it is difficult to see a "miracle" in the short term.

Correct answer: You should develop a long-term exercise plan and set small goals on a monthly and quarterly basis, such as increasing muscle strength to increase the number of squats this month, and extending your walking distance next quarter. You should also communicate with medical staff regularly and use professional equipment to assess changes in indicators such as body composition, cardiopulmonary function, and muscle strength. Optimize your exercise plan based on the results and persevere in order to reap the health benefits of exercise.

The path of scientific exercise for dialysis patients requires breaking the "shackles" of many misunderstandings. From abandoning wrong ideas, selecting sports, grasping opportunities, regulating intensity, to doing a good job of full-process protection and long-term persistence, working with medical staff to customize plans, and regularly evaluate and adjust. Only in this way can we improve our physical functions with the help of exercise, regain confidence in life, inject vitality and hope into dialysis life, and embrace a better quality of life. Let us take action and use scientific exercise to sustain our health.

Author: Liu Haoran, Hemodialysis Room, Department of Nephrology, Second Affiliated Hospital of Naval Medical University